The foot is composed of 26 major and 2 minor bones. That means, your two feet have 25% of all the bones in your body. In addition to these bones, each foot contains thirty-three joints. Five of those joints are made of the bones in the ball of your foot. These are called metatarsal phalangeal joints, or MTPJ’s for short. These joints allow your toes to bend upward, or what is called dorsiflexion. You create this movement by rolling up onto the ball of your feet. Although this movement seems simple, it’s one part of a more complex system of joint movements designed to stabilize your feet as you walk and run.

What is metatarsalgia?
Metatarsalgia is a medical term used to describe pain in the MTPJ’s. It’s rather non-specific and encompasses a large collection of painful conditions. As doctors, we use this term when other more specific causes of foot pain have been ruled out leaving only generalized pain in the metatarsal phalangeal joints.

How does metatarsalgia occur?
Metatarsalgia is an overuse type injury involving the MTPJ’s, and as such, activity is the primary cause of pain in these joints and bones. Running, jumping, dancing, and any other activity which places excess strain on the ball of the foot can cause metatarsalgia. Even wearing high-healed shoes can cause it. It has even been noted in people who spend a lot of time sitting at a desk with one foot slightly behind them with the toes bent backwards. Some foot types such as high arches (pes cavus) place excess pressure on the ball of the foot that leads to metatarsalgia.

How metatarsalgia diagnosed?
Your doctor will examine your feet and rule out other causes of pain. Other conditions such as neuromas, arthritis, capsulitis, and tendonitis can mimic the pain of metatarsalgia. X-rays are normally used to help in the diagnosis of metatarsalgia. Sometimes an ultrasound or MRI are needed to conclude why there is pain.

How is metatarsalgia treated?
The basis of treating metatarsalgia involves reducing inflammation and the mechanical strain on the joints and bones in the ball of the foot. Ice, anti-inflammatory medication, and sometimes cortisone injections are effective in reducing inflammation and pain. Treatment may also include soft insoles for your shoes, arch supports and orthotics, and soft shoes. Often times, tight calf muscles cause excess pressure on the ball of the foot and metatarsalgia. Consequently, calf stretches play an important role in treating metatarsalgia. In the vast majority of cases, conservative treatment is effective, but surgery is sometimes necessary when all other treatments have failed.

This information is not intended to diagnose, treat, or prevent any injury or disease. It is intended to serve as an overview of running-related injuries and should not be used as a substitute for sound medical advice from a doctor or therapist.